Urgent! UM Case Manager Job Opening In Remote – Now Hiring Healthfirst
****This position is 100% Remote**
**Duties//Responsibilities:**
+ **Provides case management services for assigned member caseloads which includes:**
+ **Pre-certification performing risk-identification, preadmission, concurrent, and retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations based on clinical documentation, regulatory, and InterQual//MCG criteria**
+ **Assessment - identifying medical, psychological, and social issues that need intervention.**
+ **Coordination - partnering with PCP and other medical providers to coordinate treatments, collateral services, and service authorizations.
Negotiates rates with non-partner providers, where applicable.
Ensures appropriate access and utilization of a full continuum of network and community resources to support health and recovery**
+ **Documenting - documenting all determinations, notifications, interventions, and telephone encounters in accordance with established documentation standards and regulatory guidelines.**
+ **Reports and escalates questionable healthcare services**
+ **Meets performance metric requirements as part of annual performance appraisals**
+ **Monitors assigned case load to meet performance metric requirements**
+ **Functions as a clinical resource for the multi-disciplinary care team in order to maximize HF member care quality while achieving effective medical cost management**
+ **Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments**
+ **Occasional overtime as necessary**
+ **Additional duties as assigned** **Minimum Qualifications:** **RN, LPN, LMSW, LMHC,LMFT, LCSW, PT, OT, and//or ST license** **For CASAC positions only: Credentialed Alcohol and Substance Abuse Counselor** **Preferred Qualifications:**
+ **Masters degree in a related discipline**
+ **Experience in managed care, case management, identifying alternative care options, and discharge planning**
+ **Certified Case Manager**
+ **Interqual and//or Milliman knowledge**
+ **Knowledge of Centers for Medicare & Medicaid Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care**
+ **Relevant clinical work experience**
+ **Intermediate Outlook, Basic Word, Excel, PowerPoint, Adobe Acrobat skills.**
+ **Demonstrated critical thinking and assessment skills to ensure member care plans are followed.**
+ **Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment**
+ **Demonstrated professional writing, electronic documentation, and assessment skills.**
WE ARE AN EQUAL OPPORTUNITY EMPLOYER.
Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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Unlock Your UM Case Potential: Insight & Career Growth Guide
Real-time UM Case Jobs Trends in Remote, United States (Graphical Representation)
Explore profound insights with Expertini's real-time, in-depth analysis, showcased through the graph below. This graph displays the job market trends for UM Case in Remote, United States using a bar chart to represent the number of jobs available and a trend line to illustrate the trend over time. Specifically, the graph shows 21883 jobs in United States and 55 jobs in Remote. This comprehensive analysis highlights market share and opportunities for professionals in UM Case roles. These dynamic trends provide a better understanding of the job market landscape in these regions.
Great news! Healthfirst is currently hiring and seeking a UM Case Manager to join their team. Feel free to download the job details.
Wait no longer! Are you also interested in exploring similar jobs? Search now: UM Case Manager Jobs Remote.
An organization's rules and standards set how people should be treated in the office and how different situations should be handled. The work culture at Healthfirst adheres to the cultural norms as outlined by Expertini.
The fundamental ethical values are:The average salary range for a UM Case Manager Jobs United States varies, but the pay scale is rated "Standard" in Remote. Salary levels may vary depending on your industry, experience, and skills. It's essential to research and negotiate effectively. We advise reading the full job specification before proceeding with the application to understand the salary package.
Key qualifications for UM Case Manager typically include Other General and a list of qualifications and expertise as mentioned in the job specification. Be sure to check the specific job listing for detailed requirements and qualifications.
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Here are some tips to help you prepare for and ace your job interview:
Before the Interview:To prepare for your UM Case Manager interview at Healthfirst, research the company, understand the job requirements, and practice common interview questions.
Highlight your leadership skills, achievements, and strategic thinking abilities. Be prepared to discuss your experience with HR, including your approach to meeting targets as a team player. Additionally, review the Healthfirst's products or services and be prepared to discuss how you can contribute to their success.
By following these tips, you can increase your chances of making a positive impression and landing the job!
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